patho ch34.txt

• acute renal failure is rapid decline in kidney function
• can be prerenal,intrarenal,postrenal
• 80-95% pre or intrinsic
• if treated early, kidney function may be restored

prerenal decreases perfusion of kidneys, most common, hypovolumia,afferent vasoconstriction, blood flow down below 25% ishemia, elevated BUN to creatinine

• results from damage to kidney structures,
• ATN - tubular epithelial, from sepsis or hypovolumia
• from toxic insult, tubular obstruction or ischemia

• results from obstruction of urine outflow,
• ureter, bladder, or urethra (prostatic hyperplasia)
• usually must be bilateral to cause failure

• destruction of tubular epithelial cells,
• caused by toxic,ischemia,sepsis,obstruction or infection
• onset or initiation - time of event to tubular injury
• maintenance - decreased GFR, retention,edema,oliguria
• recovery - repair of renal tissue,increase in urine output,

hypertension then diabetes

• CKD is kidney damage or GFR<60 for 3 months or longer
• 1-kidney damage GFR>=90
• 2 - kidney damage GFR 60-89
• 3 - GFR 30-59
• 4 - GFR 15-29
• 5 - FAILURE GFR < 15 or dialysis

• normal GFR 120-130
• serum creatinine or 24 urine creatinine
• increase in Albuminuria

• inability to concentrate urine,
• inability to regulate sodium,
• hyperkalemia develops late
• acidosis due to decreased H+ excretion and bicarb reabsorbtion

• abnormal Ca and Ph occur early
• serum Ph rises due to lack of excretion thus,
• Ca levels fall, PTH rises, demineralization, reduced activation of Vitamin D
• anemia due to decreased EPO, blood loss, low iron, and blood urea

• hypertension due to increased fluid, renin-angiotensin, possible uremic pericarditis
• immune and inflamation can be limited by blood urea

• uremia can demylenate cause neuropathy
• uremia can affect CNS
• skin can be pale due to anemia,dry skin,itching
• sexual from neural,hormonal,and drugs used to treat

• many drugs and metabolites are elimnated by the kidney,
• decreased albumin means more drug is free to act

• blood delivery system
• dialyzer - artificial tubular filter takes blood cells and proteins, substances can be added
• dialysis fluid delivery system, to arteriovenous shunt
• peritonal dialysis - dialyzing solution added to the peritoneal cavity, dwells for osmosis then is drained

histocompatibilty, adequate organ preservation, and immune management. immunosupressants given,

• restriction of dietary proteins descreases breakdown to BUN and acids
• limitation of sodium and fluid
• limit phosphorus intake

• children < 5yo - congenintal malformation
• children > 5yo - aquired and inherited disorders
• special problems with growth and development

• normal aging decreases GFR
• secondary disease causes of CKD more common
• secondary diseases can be treated and nephrotoxic drugs can be avoided

• children - transplant,dialysis,
• elderly - different monitoring standards due to decreased muscle mass, individualized hemodialysis, decreased transplants with age

• acute-abrupt in onset, often reversible if recognized early and treated appropriately
• chronic-end result of irreparable damage to kidneys, develops slowly

• prerenal - decreased renal perfusion
• intrinsic-damage to structures within kidney
• postrenal-obstruction of urine outflow from kidney

prerenal

• hypertension
• diabetes mellitus
• polycystic kidney disease
• obstructions of urinary tract
• glomerulonephritis-autoimmune,strep,empitigo
• cancers-renal cell, urolithial
• autoimmune disorders - ESL
• Disease of heart or lungs - CHF
• chronic use of pain medication

• prompt treatment of UTI - prevent pyelonephritis
• avoid nephrotoxic medication
• control blood pressure
• control blood sugar in diabetes
• stop smoking

thickens basement membrane, kidney becomes less compliant

• accumulation of nitrogenous wastes
• alterations in fluid electrolyte balance
• mineral and skeletal disorder
• anemia and coagulation disorder
• GI disorders
• hypertension and cardiovascular disorder
• neurologic complications
• disorders of skin integrity
• immunologic disorder